The crowd of health issues jostling for a share of Kenya's inadequate health budget is expanding, with activists calling for an increase in resources for the management of non-communicable diseases (NCDs), which account for more than 50 percent of hospital deaths and admissions.
"We need to see more commitment in terms of resources; we have policies and guidelines for the management of non-communicable illnesses, but we need strategic focus on operational implementation," said Andrew Suleh, medical superintendent of Mbagathi District Hospital in the Kenyan capital, Nairobi.
According to the NGO, NCD Alliance , NCDs are responsible for more than half of all hospital admissions and deaths; 13 percent of deaths are due to cardiovascular disease, while cancers account for 7 percent and diabetes for 4 percent of deaths, respectively.
The UN World Health Organization's 2011 World Health Statistics report , states that the Kenyan government spends just 5.8 percent of its budget on health; this represents less than half of the 15 percent pledged by African leaders under the Abuja Declaration of 2001.
Worryingly for health activists, government spending on health appears to be shrinking rather than growing; in 2000, health spending was 9 percent of total government expenditure and reliance on external sources for health funding rose from 8.8 percent in 2000 to 26.8 percent, according to WHO.
"The health service is overwhelmed; at Kenyatta [National Hospital, the country's largest referral facility] we perform open-heart surgery twice a week - our waiting list is up to 2013," said James Munene, head of the Cardiac Unit. "We are dealing with a situation where the population has grown but we still have the same number of facilities and the same number of qualified personnel.
"Risk reduction efforts are not working - the messages about HIV prevention and TB and other communicable illnesses have been very clear and evident, but we don't see efforts to ensure proper nutrition, exercise - the things that could prevent many of these NCDs," he added. "Perhaps because we have so much starvation in parts of the country we are afraid to advise those who have food on how to eat right."
Worries over HIV funding
Against a backdrop of two consecutive rejections by the Global Fund to fight AIDS, Tuberculosis and Malaria and flat-lined funding from the US President's Emergency Plan for AIDS Relief, HIV activists worry that any move to increase funding for NCDs could mean less for HIV. Just 440,000 out of 1.5 million HIV-positive Kenyans have access to treatment, and more than 100,000 new HIV infections occur annually.
"NCDs are sexy now, last year it was maternal health; there doesn't seem to be a genuine commitment by government to fully address any of these issues... where are the results? The government must not forget about people living with HIV," said James Kamau, coordinator of the Kenya Treatment Access Movement. "Where is the 15 percent they promised - that way, we could improve treatment of all illnesses."
Kamau noted that if all Kenyans who required HIV treatment had access to it, the government would reduce the costs of treating opportunistic infections, freeing up vital manpower and other resources to treat other illnesses.
But boosting resources for NCDs would be beneficial to people with HIV, as studies show they are at higher risk for conditions such as cardiovascular disease.
On the same side
According to a 2011 study of more than 12,000 HIV-positive men and women in western Kenya, there is a high prevalence of hypertension and obesity - both linked to cardiovascular disease - among HIV-positive patients in that part of the country. The prevalence of hypertension among men and women was 11.2 percent and 7.4 percent respectively, while 11 percent of men and 22.6 percent of women were overweight or obese.
The authors recommended that HIV care in sub-Saharan Africa should include identification and management of cardiovascular risk factors.
"Programmes in sub-Saharan Africa that focus solely on HIV care are missing a major opportunity to improve population health status at a substantial future cost," they said.
A 2010 study of a programme by the NGO, Family Health International, to integrate cardiovascular disease management and HIV care in Kenya found that cardiovascular disease screening and management were feasible in routine HIV care.
According to Mbagathi Hospital's Suleh, the demands for more health funding should not put the various health activists at odds with each other, but rather should unite them to ensure the government fulfils its obligations.
"This should not be a competition - the same government is responsible for ensuring that HIV and NCDs are fully funded," said Suleh. "There has been more emphasis on communicable diseases like HIV, malaria and TB; there must be a balance and proper planning to ensure all these vital areas receive due attention."
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